Primary Care Follow-up Research Articles

Fever and Abdominal Pain in a 10-year-old with Autism.

Fever and Abdominal Pain in a 10-year-old with Autism.

Can I Send This Syncope Patient Home From the Emergency Department?

Syncope is a common presentation to the emergency department (ED). A significant minority of these patients have potentially life-threatening pathology. Reliably identifying that patients require hospital admission for further workup and intervention is imperative. In patients who present with syncope, is there a reliable decision tool that clinicians can use to predict the risk of adverse outcome and determine who may be appropriate for discharge? Four articles were reviewed. The first retrospective study found no difference in mortality or adverse events in patients admitted for further evaluation rather than discharged home with primary care follow-up. The next two articles examined the derivation and validation of the Canadian Syncope Risk Score (CSRS). After validation with an admission threshold score of -1, the sensitivity and specificity of the CSRS was 97.8% (95% confidence interval [CI] 93.8-99.6%) and 44.3% (95% CI 42.7-45.9%), respectively. The last article looked at the derivation of the FAINT score, a recently developed score to risk stratify syncope patients. A FAINT score of ≥ 1 (any score 1 or higher should be admitted) had a sensitivity of 96.7% (95% CI 92.9-98.8%) and specificity 22.2% (95% CI 20.7-23.8%). Syncope remains a difficult chief symptom to disposition from the ED. The CSRS is modestly effective at establishing a low probability of actionable disease or need for intervention. However, CSRS might not reduce unnecessary hospitalizations. The FAINT score has yet to undergo validation; however, the initial derivation study offers less diagnostic accuracy compared with the CSRS.

Feasibility of a randomized hypertension screening initiative in the perioperative setting

ObjectivesThis study sought to assess feasibility of a randomized trial of blood pressure intervention (home blood pressure monitoring vs. counseling) in the preoperative clinic and the baseline rates of primary care follow-up after such interventions.MethodsA prospective randomized feasibility study was performed at Yale New Haven Hospital Preadmission Testing Clinic. A sample of 100 adults, with elevated blood pressure, were recruited during their preadmission visit, and randomized 1:1 to receive brief BP counseling and an educational brochure versus additionally receiving a home BP monitor (HBPM) with a mailed report of their home readings. At 60-day post-surgery telephone follow-up, investigators asked whether participants had primary-care follow-up; had new/adjusted hypertension treatment; and felt satisfied with the study.ResultsThere were 51 patients in the counseling group and 49 in the HBPM group. Of 46 patients in the HBPM group who returned their monitors, 36 (78%) were hypertensive at home. At 60 days post-surgery, 31 (61%) patients in the counseling group and 30 (61%) in the HBPM group were reached by telephone with the remaining followed by EHR. Thirty-six (71%) patients in the counseling group and 36 (73%) in the HBPM group had seen their primary care provider. Seventeen of 36 (47%) in the counseling group and 18 of 31 (58%) in the HBPM group received new or adjusted hypertension medications. Sixty-one participants answered questions regarding their satisfaction with the study with 52 (85%) reporting that they felt moderately to very satisfied.ConclusionsThis feasibility study suggests that interventional blood pressure trials in the preoperative clinic are feasible, but telephone follow-up leads to significant gaps in outcome ascertainment.Trial registrationClinicaltrials.gov, NCT03634813. Registered 16 of August 2018.

Abstract 13582: A Quality Improvement Project to Increase Primary Care Follow Up After Congestive Heart Failure Exacerbation in an Academic Medical Center Using a Quality and Safety Award

Introduction: Readmission after Congestive heart failure (CHF) exacerbation may be reduced by early follow-up with primary care physicians (PCP). We present a resident-driven quality improvement (QI) initiative to increase early follow-up for Veterans after CHF exacerbation. Primary outcomes were percentage of PCP follow-up within 7-days and median time to follow-up. Secondary outcomes were percentage of patients attending a PCP visit within 7-days, 30-day readmission, and mortality. Methods: This pre-post quasi-experimental study evaluated concurrent QI interventions including a standardized discharge scheduling order, monthly education, and aggregated performance feedback for medical residents with an award to the team with the highest rate of PCP appointments scheduled within 7-days (Fig 1). Patient characteristics and outcomes for a 6-month historic period and 6-month intervention period were compared using test of proportions and Wilcoxon Rank-Sum test. Results: A total of 294 patients were discharged due to CHF exacerbation (161 in historic group and 133 in intervention group). Appointments scheduled within 7-days increased from 43% to 79% (p<0.001). Median time to follow-up decreased from 8 to 6 days (p<0.001). A control chart is shown in figure 2. Patients who completed a PCP appointment within 7-days increased from 16% to 41% (p<0.001). 30-day readmission and mortality were unchanged. Conclusion: A standardized discharge scheduling order, robust resident education, and a monthly patient safety and quality award resulted in a significant increase in the rate of primary care follow-up within 7-days of CHF exacerbation.

Type of treatment, symptoms and patient satisfaction play an important role in primary care contact during prostate cancer follow-up: results from the population-based PROFILES registry

BackgroundWith the increasing attention for the role of General Practitioners (GPs) after cancer treatment, it is important to better understand the involvement of GPs following prostate cancer treatment. This study investigates factors associated with GP contact during follow-up of prostate cancer survivors, such as patient, treatment and symptom variables, and satisfaction with, trust in, and appraised knowledge of GPs.MethodsOf 787 prostate cancer survivors diagnosed between 2007 and 2013, and selected from the Netherlands Cancer Registry, 557 (71%) responded to the invitation to complete a questionnaire. Multivariable logistic regression analyses were performed to investigate which variables were associated with GP contact during follow- up.ResultsIn total, 200 (42%) prostate cancer survivors had contact with their GP during follow-up, and 76 (16%) survivors preferred more contact. Survivors who had an intermediate versus low educational level (OR = 2.0) were more likely to have had contact with their GP during follow-up. Survivors treated with surgery (OR = 2.8) or hormonal therapy (OR = 3.5) were also more likely to seek follow-up care from their GP compared to survivors who were treated with active surveillance. Patient reported bowel symptoms (OR = 1.4), hormonal symptoms (OR = 1.4), use of incontinence aids (OR = 1.6), and being satisfied with their GP (OR = 9.5) were also significantly associated with GP contact during follow-up.ConclusionsEducation, treatment, symptoms and patient satisfaction were associated with GP contact during prostate cancer follow-up. These findings highlight the potential for adverse side-effects to be managed in primary care. In light of future changes in cancer care, evaluating prostate cancer follow-up in primary care remains important.

Postpartum Transition of Care: Racial/Ethnic Gaps in Veterans’ Re-Engagement in VA Primary Care after Pregnancy

Pregnancy presents an opportunity to engage veterans in health care. Guidelines recommend primary care follow-up in the year postpartum, but loss to follow-up is common, poorly quantified, and especially important for those with gestational diabetes (GDM) and hypertension. Racial maternal inequities are well-documented and might be exacerbated by differential postpartum care. This study explores variation in postpartum re-engagement in U.S. Department of Veteran Affairs health care system (VA) primary care to identify potential racial/ethnic inequities in this care transition.We conducted a complete case analysis of the 2005-2014 national VA birth cohort (n = 18,414), and subcohorts of veterans with GDM (n = 1,253) and hypertensive disorders of pregnancy (HDP; n = 2,052) using VA-reimbursed discharge claims and outpatient data. Outcomes included incidence of any VA primary care visit in the postpartum year; in age-adjusted logistic regression, we explored race/ethnicity as a primary predictor.In the year after a VA-covered birth, the proportion of veterans with one or more primary care visit was 53.8% overall, and slightly higher in the GDM (56.0%) and HDP (57.4%) subcohorts. In adjusted models, the odds of VA primary care follow-up were significantly lower for Black/African American (odds ratio, 0.87; 95% confidence interval, 0.81-0.93), Asian (odds ratio, 0.76; 95% confidence interval, 0.61-0.95), and Hawaiian/other Pacific Islander (odds ratio, 0.73; 95% confidence interval, 0.55-0.96) veterans, compared with White veterans. Among the subcohorts with GDM or HDP, there were no significant associations between primary care and race/ethnicity.One-half of veterans re-engage in VA primary care after childbirth, with significant racial differences in this care transition. Re-engagement for those with the common pregnancy complications of HDP and GDM is only slightly higher, and less than 60%. The potential for innovations such as VA maternity care coordinators to address such gaps merits attention.

S282 Association Between Colorectal Cancer (CRC) and Disease Stage in Patients Undergoing Screening Versus Diagnostic Procedures in a Public Hospital in New York City

Introduction: Effective screening programs have reduced CRC incidence by up to 70% in specific populations. However, participation rates are low especially among disadvantaged populations. We compared demographics, disease characteristics, and clinical stages of CRC patients referred for screening (S) or diagnostic (D) procedures. Methods: We constructed a de-identified database of CRC patients seen between January 1, 2016, and June 1, 2021. Patients who were symptomatic and underwent a diagnostic procedure (D), and patients who were referred for screening colonoscopy (S) were compared. Demographic and clinical data were extracted from the electronic health record. Variables of interest included age, sex, race, BMI, cigarette smoking, diabetes, continuity (seen > once in a primary care setting (Family Medicine, Internal Medicine, ObGyn) within 5 years of being diagnosed with CRC) vs non-continuity patients, right vs left colon (separated at splenic flexure), and non-advanced (Stages 0-2) vs advanced (Stages 3-4). Fisher exact test was used to compare stage, sex, presence of symptoms, and lesion location between the two groups. Two tailed t test was used to compare BMI and age. Results: 292 patients were included, 69.2% were (D) while 27.3% were (S). Of the 292 patients, 54.4% was found to have advanced CRC and 42.4% non-advanced. Mean age was 62, there were 55% women and 45% men, and around 75% percent were African American or Hispanic. Mean BMI was 27.8, 35% were diabetic, and 54.4% had a history of cigarette smoking. Around 80% of patients had signs or symptoms at diagnosis. There was a significant difference in disease stage between D and S; 83% of D had advanced CRC at diagnosis versus 17 % in S, (p< 0.001). A greater proportion of D patients had a history of smoking (p< 0.005). Differences in sex, age, BMI, and location between D and S were not statistically significant. Conclusion: In this retrospective study of CRC screening in two public hospitals, advanced CRC was more common in symptomatic patients. We also found that more than 2/3 of our continuity patients with CRC presented with symptoms compared to >90% of non-continuity CRC patients (data reported separately). Separate approaches are needed to increase the uptake of screening of CRC and to increase the amount of people that establish a primary care follow-up, in this disadvantag population.

In-Network Primary Care: An Important Augmentation To Preoperative Workup For Patients Undergoing Infrainguinal Bypass

Vascular surgery patients have the most comorbid chronic diseases of any surgical subspecialty that warrants consistent medical management through in-network primary care physicians (PCPs). However, a paucity of data is available regarding the role of PCP care for those requiring vascular surgery. We assessed in-network primary care follow-up before infrainguinal bypass (lower extremity bypass) and hypothesized that most patients would not have received PCP in-network visits and that those with in-network PCP visits would have better a record of preoperative comorbidities.

SARS-CoV-2 pneumonia follow-up and long COVID in primary care: A retrospective observational study in Madrid city.

Patients with COVID-19 are follow-up in primary care and long COVID is scarcely defined. The study aim was to describe SARS-CoV-2 pneumonia and cut-offs for defining long COVID in primary care follow-up patients. A retrospective observational study in primary care in Madrid, Spain, was conducted. Data was collected during 6 months (April to September) in 2020, during COVID-19 first wave, from patients ≥ 18 years with SARS-CoV-2 pneumonia diagnosed. Variables: sociodemographic, comorbidities, COVID-19 symptoms and complications, laboratory test and chest X-ray. Descriptive statistics were used, mean (standard deviation (SD)) and medians (interquartile range (IQR)) respectively. Differences were detected applying X2 test, Student's T-test, ANOVA, Wilcoxon-Mann-Whitney or Kruskal-Wallis depending on variable characteristics. 155 patients presented pneumonia in day 7.8 from the onset (79.4% were hospitalized, median length of 7.0 days (IQR: 3.0, 13.0)). After discharge, the follow-up lasted 54.0 median days (IQR 42.0, 88.0) and 12.2 mean (SD 6.4) phone calls were registered per patient. The main symptoms and their duration were: cough (41.9%, 12 days), dyspnoea (31.0%, 15 days), asthenia (26.5%, 21 days). Different cut-off points were applied for long COVID and week 4 was considered the best milestone (28.3% of the sample still had symptoms after week 4) versus week 12 (8.3%). Patients who still had symptoms >4 weeks follow-up took place over 81.0 days (IQR: 50.5, 103.0), their symptoms were more prevalent and lasted longer than those ≤ 4 weeks: cough (63.6% 30 days), dyspnoea (54.6%, 46 days), and asthenia (56.8%, 29 days). Embolism was more frequent in patients who still had symptoms >4 weeks than those with symptoms ≤4 weeks (9.1% vs 1.8%, p value 0.034). Most patients with SARS-CoV-2 pneumonia recovered during the first 4 weeks from the beginning of the infection. The cut-off point to define long COVID, as persisting symptoms, should be between 4 to 12 weeks from the onset of the symptoms.

A Quality Improvement Initiative Addressing Provider Prescription of Weight Management Follow-up in Primary Care.

Introduction:Few providers routinely comply with the American Academy of Pediatrics recommendations to prescribe weight management follow-up in-between well-child checks for children with obesity/overweight. This quality improvement (QI) project aimed to increase the percentage of patients prescribed weight management follow-up within three months of their well-child check.Methods:The project took place in 1 outpatient primary care clinic at a large, free-standing children’s hospital from May 2018 to April 2019. We grouped interventions in 4 Plan-Do-Study-Act ramps with the following themes: (1) provider education; (2) electronic health record note changes; (3) discharge order modifications; and (4) provider feedback. The primary outcome was the percent of patients ages 2–18 years with body mass index ≥ 85% that had an order placed to schedule a follow-up weight management appointment in primary care. We monitored attendance rates for scheduled follow-up visits as a balancing measure.Results:Mean prescription rates increased from 32% at baseline to 58%, with special cause analysis demonstrating improvement. Of patients prescribed follow-up, 40% returned for a weight management visit, compared to 13% before the QI initiative. The no-show rate was 35%.Conclusions:The utilization of QI methodology led to an increase in the percentage of patients appropriately prescribed weight management follow-up and a resultant increase in the number of patients seen for follow-up. The next steps include a re-examination of process failures to improve patient buy-in in follow-up prescriptions.

Prevalence and risk factors for gastrointestinal symptoms after recovery from COVID-19.

BackgroundCOVID‐19 frequently presents with acute gastrointestinal (GI) symptoms, but it is unclear how common these symptoms are after recovery. The purpose of this study was to estimate the prevalence and characteristics of GI symptoms after COVID‐19.MethodsThe medical records of patients hospitalized with COVID‐19 between March 1 and June 30, 2020, were reviewed for the presence of GI symptoms at primary care follow‐up 1 to 6 months later. The prevalence of new GI symptoms was estimated, and risk factors were assessed. Additionally, an anonymous survey was used to determine the prevalence of new GI symptoms among online support groups for COVID‐19 survivors.Key ResultsAmong 147 patients without pre‐existing GI conditions, the most common GI symptoms at the time of hospitalization for COVID‐19 were diarrhea (23%), nausea/vomiting (21%), and abdominal pain (6.1%), and at a median follow‐up time of 106 days, the most common GI symptoms were abdominal pain (7.5%), constipation (6.8%), diarrhea (4.1%), and vomiting (4.1%), with 16% reporting at least one GI symptom at follow‐up (95% confidence interval 11 to 23%). Among 285 respondents to an online survey for self‐identified COVID‐19 survivors without pre‐existing GI symptoms, 113 (40%) reported new GI symptoms after COVID‐19 (95% CI 33.9 to 45.6%).Conclusion and inferencesAt a median of 106 days after discharge following hospitalization for COVID‐19, 16% of unselected patients reported new GI symptoms at follow‐up. 40% of patients from COVID survivor groups reported new GI symptoms. The ongoing GI effects of COVID‐19 after recovery require further study.

Monitoring New Symptoms After COVID-19 Infection Among Primary Care Patients in New York City.

COVID-19 affects multiple organ systems causing substantial long-term morbidity. The implications of the Post-Acute Sequelae of SARS-CoV-2 infection, particularly for primary care, remain unknown. This cross-sectional study examines new symptoms reported at primary care encounters during three post-acute follow-up intervals after initial SARS-CoV-2 infection. Electronic health record data from the NYU Langone COVID Deidentified Dataset were queried for adults with a positive SARS-CoV-2 PCR test, and then restricted to those with a new ICD-10-CM code documented at a post-acute COVID-related primary care follow-up >14 days after testing positive. New diagnoses and the corresponding Clinical Classifications Software Refined categories were assessed at the following intervals: 0.5-3 months ("subacute"), 3-6 months ("prolonged"), and 6-9 months ("persistent"). Out of 3,154 patients, a new ICD-10-CM code was documented among 499 patients (∼16%). Respiratory complaints, including cough, shortness of breath, dyspnea, and hypoxemia, were most common. Malaise and fatigue were reported consistently among 10-13% of patients at all three time-intervals. Musculoskeletal pain, circulatory symptoms, and sleep-wake disorders were also observed at primary care follow-up. This cross-sectional study provides support of a post-acute COVID syndrome, demonstrating that patients continue to experience symptoms after the acute infection period. Extensive follow-up data allowed for examining new symptoms up to 9 months after initial SARS-CoV-2 infection. Understanding of the course of multi-organ post-acute sequelae is restricted by cross-sectional study design limitations. Standardized, sequelae-related ICD-10-CM codes to specify the type and duration of post-acute COVID-related symptoms would enable better monitoring of the growing number of SARS-CoV-2 infection survivors.

Community-Level Characteristics of Timely PCP Follow-Up Care and Post-Discharge ER Usage

Achieving equitable access has been a central goal in healthcare for years; access by low-income Americans is a major concern for policymakers. We examined the differences in post-discharge primary care follow-up visits and 30-day post discharge ER visits across several characteristics. The results suggest that higher housing density, percent minority population, percent unemployed, and percent uninsured point to lower rates of PCP follow-up care and higher rates of post-discharge ER visits. These findings have implications for developing cost-effective programs targeting hospital to PCP communication, especially in densely populated areas.

Prospective Study on Factors Associated with Referral of Patients with Opioid Maintenance Therapy from Specialized Addictive Disorders Centers to Primary Care.

Background: One of the most important issues for opiate maintenance therapy efficacy is the involvement of primary care physicians (PCPs) in opiate use disorder treatment, especially after referral from specialized units. This study aimed to analyze the progress of subjects in a specialized center and after referral to PCPs. Methods: This study was an observational prospective study. Recruitment took place in a specialized addictive disorder center in western France. All patients were evaluated (sociodemographical data, severity of substance use disorders through the TMSP scale, the quality of life through the TEAQV scale) by physicians during the 5-year-follow up of the study. Analysis focused on four main times during follow-up: entry/last visit into specialized care and into primary care. Results: 113 patients were included in this study; 93% were receiving methadone and 7% buprenorphine. Ninety (90) were referred to primary care. In primary care follow-up, the probability of the lowest severity score for substance use disorders remained stable over time. Conclusions: In daily practice, a center specialized in addictive disorders referred OMT management to PCPs for a majority of patients, and benefits regarding substance use disorders severity and quality of life remained stable after referral. Our results need to be confirmed.

Sociodemographic determinants of chronic kidney disease in Indigenous children.

Rates of chronic kidney disease (CKD) are disproportionately increased in Indigenous peoples. The focus has traditionally been on adults, as they experience the highest rates of kidney failure requiring kidney replacement therapy. The impacts of colonization, systemic racism, and sociodemographic marginalization however impact the health of Indigenous peoples across the lifespan. This review presents the social context within which Indigenous children develop and the impact relevant to kidney health across the developmental stages. In utero exposures impact nephron endowment which can manifest in glomerular hyperfiltration and sclerosis as well as an increased risk of congenital anomalies of the kidney and urinary tract. Young children are at increased risk of autoimmune conditions, secondary to infectious and environmental exposures, and are also exposed to the impacts of a Western lifestyle manifesting early onset overweight/obesity. Adolescents begin to manifest more severe metabolic complications such as type 2 diabetes. The impacts of early onset diabetes are associated with aggressive kidney complications and high rates of kidney failure in young adulthood. Finally, the key elements of successful prevention and treatment strategies are discussed including the importance of screening for asymptomatic, modifiable early disease, linked with clinical primary and tertiary care follow-up, and culturally relevant and safe care.

Patient preferences for cancer survivorship care: Results of an online survey.

12064 Background: Nearly 17 million cancer survivors live in the United States. Workforce shortages are projected to diminish the number of available medical oncologists (MOs) to care for newly diagnosed patients with cancer and for the growing number of cancer survivors. Models of survivorship care include oncologist-led, primary care-led, and shared care approaches. Recent proposals recommend a risk-stratified approach to care, guided by individual and cancer-specific factors, but there is little evidence regarding patient preferences for non-oncologist survivorship care. Methods: We developed a survey in partnership with patient advocates. The primary endpoints were patient-reported comfort with survivorship care by a primary care provider (PCP) or in a dedicated survivorship clinic. We distributed the survey to online, cancer-specific patient communities from June to August 2020. Logistic regression analyses were adjusted for patient age, race and ethnicity, insurance, and cancer type and stage. Results: Of 1166 responses, 975 surveys were complete and available for analysis. Respondents were primarily women (91%), white (92%), and US residents (73%); 78% had a college or graduate degree. Two-thirds had private insurance. Thirty-six different cancer types were reported; 61% of respondents had breast cancer, and 25% were treated for more than one type of cancer. Most respondents (83%) had nonmetastatic disease, 74% reported experiencing late effects of cancer therapy, and almost all (93%) had a PCP. Only 21% of respondents were comfortable seeing a PCP (versus MO) for survivorship care, including cancer follow-up, side effect management, and monitoring for recurrence or progression. About half (55%) were comfortable with follow-up in a survivorship clinic instead of with their MO. Multivariable analyses showed no significant associations between age, race or ethnicity, insurance, cancer type, or stage at diagnosis and comfort with follow-up care from a PCP or in a survivorship clinic. In analyses restricted to the 439 respondents with a history of early-stage breast cancer, the 239 (54%) who were within 1 to 5 years of diagnosis were less comfortable with PCP versus MO follow-up, compared with the 52 (12%) who were &gt; 15 years from diagnosis (OR 0.40; 95% CI 0.20–0.75; p= 0.004). In this sub-analysis, time from diagnosis was not associated with comfort being seen in a survivorship clinic. Conclusions: In our study, most patients with a history of cancer were not comfortable receiving follow-up care from their PCP. It is often recommended that survivors of early-stage breast cancer transition to primary care for follow-up and surveillance, but our study revealed comfort with this approach only many years after diagnosis. While both PCP survivorship training and patient confidence in PCP follow up is needed, preferences of cancer survivors should be considered in designing new models of survivorship care.

Implementation of a clinic to facilitate the transition from pediatric to adult cancer survivorship care.

e13519 Background: Transitions from pediatric to adult care settings are challenging for adults with a history of complex childhood illness such as cancer. We developed a new clinical model to support young adult survivors of leukemia and bone marrow transplant (BMT) with transitioning from pediatric to adult focused survivorship care. Methods: We established the GREAT (Getting Regular Evaluations After Treatment) survivorship clinic as a collaboration between the adolescent/young adult (AYA) cancer program, pediatric oncologists, and specialists in adult hematologic malignancies. New patient appointments consist of two back-to-back visits: (1) a medical survivorship visit with a pediatric oncologist and an oncologist who specializes in hematologic malignancies/BMT to review the treatment history, medical issues, risk of late effects, and surveillance recommendations, and (2) an AYA-focused visit with a nurse practitioner to review fertility, education/career, and psychosocial concerns. Patients receive a treatment summary through the Passport for Care, based on pediatric survivorship guidelines. The clinic team then communicates with the patient’s primary care provider (PCP) or assists the patient with finding a PCP. Results: Since August 2020, we have seen 17 patients (12 telehealth, 5 in-person, 53% male, 47% non-Hispanic white, 41% Hispanic/Latino, 12% Asian). The median age at clinic visit was 28 years (range 24-39) and median time since treatment was 15 years (range 1-29). Patients were referred through the AYA cancer program: 8 had been regularly followed in the pediatric survivorship clinic, 2 had not been seen in pediatric oncology/survivorship for many years, 3 were treated as children but most recently seen by adult oncologists, and 4 were treated by adult oncologists and referred for AYA-specific survivorship care. Twelve (71%) patients had a PCP they see regularly, while 2 did not have a PCP and 3 were not sure. Communication with PCPs consisted of faxing the clinic note and calling the PCP’s office. All PCPs were receptive and expressed interest in receiving survivorship care recommendations; some preferred to order late effects surveillance imaging/labs, while others preferred the GREAT clinic team to do so, illustrating the value of two-way communication. Thirteen (76%) patients participated in post-clinic interviews. All stated they would recommend the clinic to others. Common themes from interviews included understanding more about their past treatment and having greater confidence managing their health. Conclusions: The model for facilitating care transitions was highly regarded by young adult cancer survivors and highlights opportunities for improving self-management and care coordination. Future directions include expanding to more cancer types, addressing barriers to primary care follow-up, and exploring shared care or co-management with PCPs.

Retrospective review of work-related injuries sustained by foreign workers: a single centre experience over 10 years

ObjectivesTo investigate current patterns of work-related injuries sustained by foreign workers in Singapore and compare them to a decade ago. Secondary aim to analyse usefulness of selected trauma scores in...

Giving "prescriptions" for paediatric weight management follow-up in primary care.

The American Academy of Paediatrics recommends that primary care paediatricians "prescribe" follow-up for weight management between well child checks. We sought to describe rates and predictors of prescribed and actual clinic attendance for weight management in primary care in a predominantly low-income population. A chart review was performed at a large, hospital-based, primary care clinic, where a treatment algorithm for obesity exists. Eligible children were 6 to 12 years of age with a body mass index (BMI) ≥85th percentile and seen for a well child check in 2014. Primary outcomes were the physician prescribing follow-up in primary care and the patient returning for weight management. Multivariable logistic regression was used to identify predictors of prescribing follow-up and predictors of return. Participants included 1339 patients: mean age 9 years (SD: 1.8 years); 53% female; 79% Black; 89% Medicaid-insured; 56% with an obese BMI (vs overweight). Twenty-seven percent of patients were prescribed follow-up in primary care, of which 13% returned (only 4% of the original sample). The odds of the physician prescribing follow-up were greater if the child had obesity (vs overweight), was older, female or non-Medicaid insured. Older and non-Black patients had greater odds of returning. Patients prescribed follow-up within 2 months or less (vs 3-6 months) were also more likely to return (aOR 2.66; CI: 1.34, 5.26). Rates of prescription for weight management in primary care are low and few patients return, even when follow-up is prescribed. Prescribing follow-up at shorter intervals from the index visit (≤ 2 months) may improve patient return.

Posthospitalization follow-up recommendations after pediatric critical illness due to respiratory failure.

To characterize the recommended posthospitalization follow-up by provider type and location after a pediatric critical illness due to respiratory failure. After pediatric critical illness due to respiratory failure, patients will not have a standard follow-up pattern with regard to provider type or follow-up location. A retrospective cohort study. Children, 18 years or younger, admitted to a quaternary care pediatric intensive care unit with respiratory failure between January 1, 2013and December 31, 2014. For eligible patients, recommendations for posthospitalization follow-up including provider type (primary care and specialty care) and location (community care center vs. tertiary care center) were characterized from medical chart review. Recommendations were examined for all patients and two patient subgroups (patients who received extracorporeal membrane oxygenation and patients with tracheostomy). Of 155 patients alive at hospital discharge, the median age was 2.1 (interquartile range, 0.7-10.6) years. Eighty percent of patients were instructed to follow-up with a primary care provider but only 52.9% with a pulmonologist. We found 10 unique follow-up patterns between provider location (community care center, tertiary care center, or both) and global provider type (primary care versus specialty care). Primary care follow-up was recommended more often at community locations (74.2%), whereas specialty care was more often recommended at tertiary care centers (68.6%). Our study findings demonstrate significant variability in the recommendations for follow-up by provider type and location after hospitalization for acute respiratory failure and highlight areas for improvement in follow-up care after pediatric critical illness.